The recent release of the final report from the Royal Commission into Aged Care revealed poor living circumstances for many in residential aged care homes as well as lengthy wait times (e.g. in 2017–18, one-quarter of eligible people waited more than 30 months to get a Level 4 Home Care package) for people living at home who rely on Home Care support. The report reiterates that most people want to stay in their own home rather than go into residential aged care.
Cost savings to Government of home care
Importantly, supporting people to age in place can also be beneficial to governments as the cost of service per person is significantly lower when people can stay in their own home. For example, a person accessing the Commonwealth Home Support Programme (CHSP) costs the Commonwealth Government on average about $3,900 per person each year, while the cost of a person living permanently in a residential aged care facility costs the Government around $69,055 each year (plus any costs paid by the aged care resident from their own pocket).
CHSP provides entry-level services to support individuals with daily living tasks to enable them to be more independent at home and in the community. Services under the program are provided on an on-going or episodic basis, depending on need. With regards to housing, CHSP funding will provide support for home maintenance; home modifications; and goods, equipment and assistive technology.
The report reiterates that most people want to stay in their own home rather than go into residential aged care.
The more structured and comprehensive government funded Home Care Packages (HCP) costs on average $19,500 per person each year, still well below the cost of residential aged care. Home Care packages are provided over four levels: Level 1 – to support people with basic care needs, with a Government subsidy of $24.46 a day; Level 2 – to support people with low level care needs—$43.03 a day; Level 3 – to support people with intermediate care needs—$93.63 a day; and Level 4 – to support people with high care needs—$141.94 a day. A person on a Level 1 package may receive a Government subsidy of around $9,000 per year, while a person on a Level 4 package may receive about $52,000 per year (in $2020).
Table 1: Approximate cost of residential placement versus CSHP and home care 2019–20
| Cost to Commonwealth Govt. | Number of people who accessed aged care | % of all people accessing aged care | Approx. annual ongoing cost per person | % of $ allocated to aged care | |
|---|---|---|---|---|---|
| CHSP | $3.3b | 839,373 | 64% | $3,900 | 15% |
| Home care package | $3.4b | 173,743 | 13% | $19,500 | 16% |
| Residential respite | $0.7b | 66,873 | 2% | $10,400 | 3% |
| Perm. Residential | $13.4b | 244,363 | 21% | $69,055 | 63% |
| other | $0.5b | - | - | - | 3% |
| Total | $21.3b | 1,324,352 | 100% | $16,083 | 100% |
Source: 2019–20 Report on the Operation of the Aged Care Act 1997. Department of Health
What home support do people need as they age?
The need for an older person to require some form of assisted care rises over time. While only 6.3 per cent of males and 6.7 per cent of females aged 60–64 needed help with core activities in 2018 (i.e. self-care, mobility or communication), this rises as people age, reaching 35.6 per cent of males and 48.6 per cent of females for those aged 85–89.
The top two activities people aged over 65 needed help with in 2018 were health care (males 19.3%, females 25.3%) and property maintenance (males 15.6%, females 23.9%).
A survey of 831 older Australians in 2011 revealed that the features needed to help them stay in their homes included: handrails/grabrails, hob-less shower, ramped or flat entry, emergency call facilities and wider doors.
Improving access to home care
The Royal Commission identified that while about 133,000 people received a Home Care package in 2018–19, over 102,000 people were waiting for a Home Care package at their approved level on 30 June 2020. In December 2020 the Australian Government announced $850m funding for 10,000 extra home care packages, in addition to the $1.6bn for 23,000 new packages announced in the October 2020 Federal Budget.
One of the key barriers to increasing in-home support identified by experts is workforce capacity and boosting the number of workers in the sector is critical to fixing the system. To-date, as part of the response to the Royal Commission, the Federal Government has committed to spending $91.8 million over the next two financial years to fund a new workforce support program.
In December 2020 the Australian Government announced $850m funding for 10,000 extra home care packages, in addition to the $1.6bn for 23,000 new packages announced in the October 2020 Federal Budget.
Housing tenure and home care
The Royal Commission Final Report reiterates a problem with current home care support, stating ‘(t)here are many examples of the problems which can be caused by a one-size-fits-all approach. For example, much about the design and delivery of home care appears to be predicated on the assumption that people own their own home or have safe and secure housing.’
While home modifications through CHSP may be readily arranged for home owners, for older people who are renting in the private market getting permission from landlords in order to make modifications can be difficult. Rental housing is not usually designed to meet the needs of older people with physical limitations or disabilities.
Even when a private landlord is receptive to alterations being carried out for an older tenant, modifying a rental property to include these features is expensive for tenants; it’s made even more problematic when tenants don’t know how long they’re going to be able to live in the property and that they must pay to return the property to its original state when they leave.